| NPI | 1528619640 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA15800) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA061051) |
| Enumeration Date | 2019-09-20 |
| Last Update Date | 2022-10-04 |